Provider Demographics
NPI:1427083518
Name:NICHOLS, AMY N (MSW, LCSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:N
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 LAKE ALICE RD SE
Mailing Address - Street 2:
Mailing Address - City:FALL CITY
Mailing Address - State:WA
Mailing Address - Zip Code:98024-6703
Mailing Address - Country:US
Mailing Address - Phone:425-444-8861
Mailing Address - Fax:425-222-0860
Practice Address - Street 1:8290 165TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3948
Practice Address - Country:US
Practice Address - Phone:425-869-2644
Practice Address - Fax:425-867-0930
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600345771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490175106Medicare ID - Type Unspecified